POLIKLINIK KEBIDANAN

KODE ICD X INDEKS NAMA DIAGNOSA KODE

TERMINAL
N91.0 AMENORRHOEA PRIMER PRIMARY AMENORRHOE 14910
N91.1 AMENORRHOEA SEKUNDER SECONDARY AMENORRHOEA 14911
N91.4 DISMENORRHOEA (NYERI WAKTU HAID) DISMENORRHOEA (NYERI WAKTU HAID) 14946
N80 ENDOMETRIOSIS ENDOMETRIOSIS 1480
O00 KEHAMILAN EKTOPIK TERGANGGU (KET) KEHAMILAN EKTOPIK TERGANGGU (KET) 1500
N83 KISTA OVARIUM CYST OVARIUM 1483
Z34 KONTROL KEHAMILAN NORMAL SUPERVISION OF NORMAL PREGNANCY 2634
O81 MELAHIRKAN DENGAN BANTUAN FORCEPS DAN VACUUM EKSTRA
SINGLE DELIVERY BY FORCEPS AND VACUUM EXTRACTOR 1581
O80 MELAHIRKAN NORMAL SPONTAN SINGLE SPONTANEOUS DELIVERY 1580
Z39 PERAWATAN SETELAH MELAHIRKAN POSTPARTUM CARE AND EXAMINATION (PERAWATAN POST MELAHIRKAN) 2639
O08 POST KURET COMPLICATION FOLLOWING ABORTION AND ECTOPIC AND MOLAR PREGNANCY 1508
O82 SECTIO CAESARIA (SC) SINGLE DELIVERY BY CAESAREAN SECTION 1582
Z32 TEST KEHAMILAN PREGNANCY EXAMINATION AND TEST 2632

POLIKLINIK PENYAKIT DALAM (INTERNIST)

KODE ICD X INDEKS NAMA DIAGNOSA KODE
TERMINAL
J45 ASTHMA ASTHMA
J20 BRONCHITIS ACUTE ACUTE BRONCHITIS
J00 COMMON COLD ACUTE NASOPHARINGITIS ( COMMON COLD )
K30 DYSPEPSIA DYSPEPSIA
R05.9 FEVER , UNSPECIFIED FEVER , UNSPECIFIED
J11 INFLUENZA INFLUENZA VIRUS NOT IDENTIFIED
J02 PHARYNGITIS ACUTE ACUTE PHARYNGITIS
A15.0 TBC PARU TUBERCULOSIS OF LUNG. CONFIRMED BY SPUTUM MICROSCOPY WITH OR WITHOUT CULTURE GA PAKE TITIK
D64 ANEMIA OTHER ANAEMIAS
J21 BRONCHIOLITIS ACUTE ACUTE BRONCHIOLITIS
R07.4 CHEST PAIN, UNSPECIFIED CHEST PAIN, UNSPECIFIED
R05 COUGH COUGH
N30 CYSTITIS CYSTITIS
A09 DIARRHOE AND GASTROENTERITIS/GED DIARRHOE AND GASTROENTERITIS OF PRESUMED INFECTIONS ORIGIN/ GED
R51 HEADACHE ( SAKIT KEPALA ) HEADACHE ( SAKIT KEPALA )
J06 ISPA /URTI ACUTE UPPER RESPIRATORY INFECTIONS OF MULTIPLE AND UNSPECIFIEDSITES ( URTI / ISPA )
M54.5 LOW BACK PAIN LOW BACK PAIN
L04 LYMPHADENITIS ACUTE ACUTE LYMPHADENITIS
M79.1 MYALGIA MYALGIA
J18 PNEUMONIA, ORGANISM UNSPECIFIED PNEUMONIA, ORGANISM UNSPECIFIED
M06.9 RHEUMATHOID ARTHRITIS, UNSPECIFIED RHEUMATHOID ARTHRITIS, UNSPECIFIED
K74 SIROSIS HEPATIS FIBROSIS AND CIRRHOSIS OF LIVER ( CIRRHOSIS HEPATIS )
A01.0 TYPHOID FEVER ( DEMAM THPHOID ) TYPHOID FEVER ( DEMAM TYPHOID )
B01 VARICELLA ( CHICKEN POX ) VARICELLA ( CHICKEN POX )
POLIKLINIK SPESIALIS ANAK
KODE ICD X INDEKS NAMA DIAGNOSA KODE
TERMINAL
J20 BRONCHITIS ACUTE ACUTE BRONCHITIS 1020
A91 DENGUE HEMORRHAGIC FEVER (DBD) DENGUE HEMORRHAGIC FEVER (DEMAM BERDARAH DENGUE) 0.191 GA PAKE TITIK
A09 DIARRHOEA AND GASTROETERITIS (GED) DIARRHOEA AND GASTROETERITIS OF PRESUMED INFECTIOUS ORGIN (GED) 0.109
K30 DYSPEPSIA DYSPEPSIA 1130
J45 ASTHMA ASTHMA 1045
J42 BRONCHITIS KRONIS UNSPECIFIED CHRONIS BRONCHITIS 1042
J06 ISPA/URTI ACUTE UPPER RESPIRATORY INFECTIONS OF MULTIPLE ANG UNSPECIFIED SITES/URTI/ISPA 1006
Z00.1 KONTROL BAYI SEHAT ROUTINE CHILD HEALTH EXAMINATION 26001
J18 PNEUMONIA PNEUMONIA, ORGANISM UNSPECIFIED 1018
J31 RHINITIS, NASOPHARYNGITIS DAN PHARYNGITIS CHRONIS CRONIIC RHINITIS, NASOPHARYNGITIS DAN PHARYNGITIS 1031
P36 SEPSIS BACTERIAL SEPSIS OF NEWBORN (SEPSIS) 1636
A15.0 TBC PARU TUBERCULOSIS OF LUNG, CONFIRMED BY SPUTUM MICROSCOPY WITH/WITHOUT CULTURE 0.115
A01.0 TYPHOID FEVER TYPHOID FEVER 0.101.0
B34 VIRAL INFECTION OF UNSPECIFIED SITES VIRAL INFECTION OF UNSPECIFIED SITES 0.234

POLIKLINIK SPESIALIS JANTUNG

KODE ICD X INDEKS NAMA DIAGNOSA KODE
TERMINAL
120 ANGINA PECTORIS ANGINA PECTORIS 0.92.0
121 MYOCARDIAL INFECTION ACUTE (MCI ACUTE) MYOCARDIAL INFECTION ACUTE 0.921
R07.4 CHEST PAIN, UNSPECIFIED (NYERI DADA, TIDAK SPESIFIK) CHEST PAIN, UNSPECIFIED (NYERI DADA, TIDAK SPESIFIK) 18074
R06.0 DYSPNOE DYSPNOE 18060
150 HEART FAILURE (GAGAL JANTUNG) HEART FAILURE (GAGAL JANTUNG) 0.95.0
140 MYOCARDITIS ACUTE ACUTE MYOCARDITIS 0.94.0
120 UNSTABLE ANGINA UNSTABLE ANGINA 0.9200.

POLIKLINIK GIGI
KODE ICD X INDEKS NAMA DIAGNOSA KODE
TERMINAL
K02 CARIES DENTAL DENTAL CARIES 1102
K04.1 GANGGRENE PULPA NECROSIS OF PULP (PUPLPAL GANGGRENE) 11041
K05.2 PERIDONTITIS AKUT ACUTE PERIDONTITIS 11052
K05.3 PERIDONTITIS KRONIS CHRONIC PERIDONTITIS 11053

POLIKLINIK BEDAH/EMERGENCY DAN TRAUMA

KODE
KODE ICD X INDEKS NAMA DIAGNOSA
TERMINAL
R10.0 ACUTE ABDOMEN (NYERI AKUT ABDOMEN) ACUTE ABDOMEN (NYERI AKUT ABDOMEN) 18100
N23 COLIC RENAL RENAL COLIC 1423
T02 FRACTURE FRACTURES INVOLVING MULTIPLE BODY REGIONS 2002
M66 RUPTURE OF TENDON RUPTURE OF TENDON 1366
R55 SYNCOPE AND COLLAPSE SYNCOPE AND COLLAPSE 1855
N30 CYSTITIS CYSTITIS 1430
184 HAEMORRHOIDS (AMBEIN) HAEMORRHOIDS (AMBEIN) 0.984
Z09.0 KONTROL POST OPERASI FOLLOW UP AXAMINATION AFTER SURGERY FOR OTHER CONDITIONS 26090
POLIKLINIK ORTHOPAEDI
KODE ICD X INDEKS NAMA DIAGNOSA KODE
TERMINAL
S42.4 HUMERUS (LOWER), FRACTURE FRACTURE OF LOWER END OF HUMERUS 19424

POLIKLINIK SYARAF
KODE
KODE ICD X INDEKS NAMA DIAGNOSA
TERMINAL
R51 HEADACHE ( CAPHALGIA ) HEADACHE ( CAPAHALGIA ) 1851
M54.5 LOW BACK PAIN ( NYERI PUNGGUNG ) LOW BACK PAIN ( NYERI PUNGGUNG ) 13545
M79.1 MYALGIA ( NYERI OTOT , PEGAL-PEGAL ) MYALGIA ( NYERI OTOT , PEGAL-PEGAL ) 13791
H82 VERTIGO VERTIGINOUS SYNDROMES IN DISEASES IN CLASSIFIED ELSEWHERE 0.882
A89 VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM VIRAL INFECTION OF CENTRAL NERVOUS SYSTEM 0.189

POLIKLINIK MATA
KODE
KODE ICD X INDEKS NAMA DIAGNOSA TERMINAL
H26 CATARACT, OTHER OTHER CATARACT 0.826
H00.1 CHALAZION ( BINTILAN ) CHALAZION ( BINTILAN ) 0.8001
H10 CONJUNGTIVITIS ( INFEKSI CONJUNCTIVA ) CONJUNGTIVITIS ( INFEKSI CONJUNCTIVA ) 0.81
B30 CONJUNGTIVITIS VIRAL VIRAL CONJUNGTIVITIS 0.32.0
H40 GLAUCOMA GLAUCOMA 0.84.0
H00 HORDEOLUM AND CHALAZION HORDEOLUM AND CHALAZION 0.8.0.0
H52.1 MYOPIA ( RABUN JAUH ) MYOPIA ( RABUN JAUH ) 0.8521
H11.0 PTERYGIUM PTERYGIUM 0.811.0
Z01.0 PEMERIKSAAN MATA EXAMINATION OF EYES AND VISION ( TEST MATA DAN PENGLIHATAN ) 26010

POLIKLINIK THT
KODE ICD X INDEKS NAMA DIAGNOSA KODE
TERMINAL
H91.9 HEARRING LOSS HEARRING LOSS, UNSPECIFIED 0.8919
H70 MASTOIDITIS MASTOIDITIS AND REALATED CONDITIONS 0.87.0
J31 RHINITIS, NASOPHARYNGITIS DAN PHARYNGITIS KRONIS RHINITIS, NASOPHARYNGITIS DAN PHARYNGITIS KRONIS 1031
H73 MEMBRAN TYMPANIC , DISORDES OTHER DISODERS OF TYMPANIC MEMBRANES 0.873
J31.2 PHARYNGITIS KRONIS CHRONIC PHARYNGITIS 10312
J32 SINUSITIS KRONIS CHRONIC SINUSITIS 1032

POLIKLINIK KULIT DAN KELAMIN

KODE ICD X INDEKS NAMA DIAGNOSA KODE
TERMINAL

T78.4 ALLERGY ALLERGY , UNSPECIFIED 20784

L23 DERMATITIS KONTAK ALERGI ALLERGIC CONTACT DERMATITIS 1223
L40 PSORIASIS PSORIASIS 1240
L50 URTICARIA/ PRURITUS ( GATAL - GATAL ) URTICARIA/ PRURITUS ( GATAL - GATAL ) 1250
T30 COMBUTION BURN AND CORROSION, BODY REGION UNSPECIFIED 2030
L20 DERMATITIS ATOPIC ATOPIC DERMATITIS 1220
A54.9 GO ( GONNORHOEA ) GONOCOCCAL INFECTION, UNSPECIFIED 0.1549
B02 HERPES ZOSTER ZOSTER ( HERPES ZOSTER ) 0.202
L01 IMPETIGO IMPETIGO 1201
B01 VERICELLA ( CHICKENPOX) VERICELLA ( CHICKENPOX) 0.201

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